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Your Story (please provide as much detail as possible)*
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The information submitted through this form may be transmitted over unsecured email and Lakeland Health is not responsible for any loss or disruption of this email communication. By selecting the "I agree to the above Terms and Conditions" checkbox, you acknowledge these terms and conditions and consent to transmission of the form.

By submitting this form, I consent to be contacted by a representative of the Lakeland Health Marketing and Communications team, and I grant my consent for a representative of the Lakeland Health Marketing and Communications team to contact my physician about my story. I understand that I would need to give additional written permission before Lakeland Health would publish a story about me.